Benign prostatic hyperplasia ( enlarged prostate ) is a common condition, occurring in over 50% of men older than 50 years. This condition means an enlargement of the prostate, with consequent compression of the urethra. When this disease becomes symptomatic the treatment is necessary. Drugs therapy is the first choice treatment and is effective in patients with mild / medium symptoms. If after 6 months of drug therapy there is no satisfactory symptom relief, other therapeutic approaches must be considered: classical surgical intervention – prostatectomy ( for prostate of a volume over 100 cc ) or minimally invasive transurethral resection procedure TURP – for a prostate volume up to 80-100 cc). However both techniques are associated with a significant complication rate. Alternative solutions to TURP include transurethral ablation using laser or ultrasound.

Prostatic artery embolization is a relatively new therapeutic solution (2000) and belongs to interventional radiology, as first described by DeMeritt.

Indications

The selection of the patients is based on a clinical and imaging consultation. Patients with indication for PAE are men aged over 50 years with moderate or severe symptoms, with a maximum urinary flow rate (Qmax) less than 12 mL / s and up to acute urinary retention.

Patients with mild / medium symptoms have indication for PAE in case the results of the drug therapy taken for at least 6 months is not considered satisfactory. The volume of the prostate must be measured by a good quality ultrasound or MRI. There is no size limit of the adenoma for the embolization procedure.

Procedure

This procedure consists of positioning a microcatheter in each prostatic artery, followed by their embolization using 250-500 microns diameter nonabsorbable microparticles. An ischemia is induced in the adenomatous tissue followed by a gradual resorption, with consequent reduction in prostate volume. The symptoms improve relatively rapid, within days or weeks post-intervention. PAE is an interventional radiology procedure performed in a sterile angiography room by a radiologist (interventional).

The procedure duration is about 60 minutes, the average radioscopy time is 12 minutes. The patient is conscious, lying on his back. In our clinic, the preferred arterial approach is left brachial. Alternatively we can use the femoral approach. The procedure starts with local anesthesia with Xiline 2 ml (1 %) at the puncture site.

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The first part of the intervention consists in the arteriography of the pelvic vessels. A 4F Cobra diagnostic catheter is inserted under fluoroscopic control to anterior branch of the internal iliac artery (on each side). By injecting the contrast agent we identify the origin and size of each prostatic artery.

The second part of the intervention consists of supraselective catheterization of the prostatic arteries using a microcatheter, followed by embolization with 250-500 microns nonresorbable microparticles. The procedure ends when we obtain a nearly complete occlusion “near stasis” of both prostate arteries.

Is it painful?

PAE is completely painless, so the administration of analgesic medication during the procedure is not necessary.

How long does it take?

The procedure duration is about 60 minutes, the average radioscopy time is 12 minutes.

Risks

PAE is considered to be a safe therapeutic procedure with very few risks and complications. Possible minor complications are hematoma at puncture site, transient hematuria or hemospermia. So far, worldwide, no major complications to require surgery were reported. No cases of sexual dysfunction, urinary incontinence, bleeding or death associated with this procedure were reported.

After procedure

The patient is discharged 3 hours after the intervention and will follow an antiinflamator and antibiotic treatment for 10 days. In the early days postembolization symptoms of local pressure and mild discomfort may occur in a small number of cases. In patients with acute urinary retention, the blader cathether is removed 24-48 hours after embolization. The patient remains in the outpatient care for several hours to ensure he can urinate without a blader cathether.

The technical success of the procedure is defined by the embolization of at least one prostate artery. This result is obtained in 95% of cases.

The clinical improvment of the patient is rapid, in 48-72 hours after the procedure. The patient will be followed up clinical and by ultrasound 1 month, 3 months and 6 months postembolization. Between 85% and 90% of patients reported a satisfactory clinical outcome at 6 months after PAE.

In 10% of patients the symptoms may be recurrent. In such cases, a second embolization procedure is recommended.

This procedure requires just a few hours hospitalization, the patient is discharged the same day.

Immediately after the procedure, the patient receive a written result and a CD with the images of the intervention, and the referral doctor will be contacted by the ARES specialists and notified regarding the patient’s condition.

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Acest site a fost conceput cu scop informativ. El nu inlocuieste in niciun caz consultul medical. Any decisions regarding diagnosis and treatment of your condition will be made only after a medical consultation.